摘要
目的总结心脏穿透性损伤的急诊救治体会。方法回顾性分析我院2005年2月～2011年9月收治的心脏穿透伤23例患者的临床资料。结果 22例剖胸手术治疗,其中急诊室剖胸2例。院内术前时间平均24.3min。15例(65.2%)术前输液量<1 000ml,1例术前心包穿刺阴性。入院时休克15例(65.2%),其中4例血压测不到(2例获救)。合并伤19例(82.6%),剖腹术4例。自体血回输量平均854.4ml。死亡3例(13.0%),死因为失血性休克2例(均为多发伤)及急性心脏压塞1例。结论恰当的术前处理策略、早期诊断及果断剖胸是提高心脏穿透伤救治成功率的关键。
Objective To summarize the emergency therapeutic experience of penetrating cardiac injuries. Methods The clinical data of 23 cases of penetrating cardiac injuries treated in our hospital from Feb. 2005 to Sep. 2011 were studied retrospectively. Results All 22 cases including Emergency Room Thoracotomy （ERT） in 2 cases （1 was survived） underwent thoracotomy. The time from emergency department to the operating room was 10 minutes-3 hours （ average 24.3 minutes ）. The amount of preoperative infusion as fluid resuscitation was less than 1 000ml in 15 cases（ 65.2% ）. Preoperative pericardiocentesis was performed in 1 patient, yielding a false-negative result. Eight patients had associated pulmonary injuries, 3 diaphragmatic injuries, and 4 associated abdominal vis- cera injuries. Totally 15 cases（65.2% ）had an initial systolic blood pressure of less than 80mmHg（ 1 mmHg = 0. 133kPa ） , among them,4 had no detectable blood pressure （2 were survived}. The amount of auto -blood transfusion was 200-1100ml （ average 854.4ml）. The overall mortality rate was 13.0% （ 3/23 ）. Two cases died of exsanguination duo to polytrauma and 1 case died of urgent cardiac tamponade resulting from delayed diagnosis. Conclusion Appropriate strategy of preoperative treatment,early establishment of diagnosis and timely exploratory thoracotomy are key points to improve the survival rate of penetrating cardiac injuries.
出处
《创伤外科杂志》
2013年第1期5-7,共3页
Journal of Traumatic Surgery
关键词
心脏损伤
穿透伤
心脏压塞
休克
cardiac injuries
penetrating injuries
cardiac tamponade
shock
